The anticoagulant dose that quietly fails

The edition in brief

Antithrombotic undertreatment: an American Heart Association scientific statement reviews omission, non-adherence and underdosing of anticoagulants and antiplatelets in atrial fibrillation, venous thromboembolism and peripheral artery disease, links them to more stroke, embolism, recurrent thrombosis and death, and argues for structured antithrombotic stewardship. FFR-CT: in 7,836 English patients with stable chest pain followed for three years, lower CT-derived fractional flow reserve tracked a graded rise in risk independent of stenosis severity. A value of 0.7 or less was associated with about three times the risk of myocardial infarction, and a normal stenosis-specific value carried a 1.5% three-year rate of MI or cardiovascular death. PCSK9 inhibitors in acute ischaemic stroke: a meta-analysis of randomised trials found adding them to a statin was associated with better functional independence (OR 2.17) and fewer recurrent strokes (OR 0.33), but certainty was moderate to low and the trials small. Renal denervation with pulmonary vein isolation: six trials and 516 hypertensive AF patients showed less AF recurrence at 12 months (RR 0.58) and about 13 mmHg lower systolic pressure, but the AF benefit was gone by 24 months.